About Dementia: Positive Approach to Care Skills


About PAC Skills

Positive Approach to Care skills are common-sense, practical skills to use with anyone living with brain change to get in and get connected before getting the task done...

Knowing your agenda, not showing your agenda!

What are the PAC Skills:

  • Relationship before Task
  • Know your agenda, don't show your agenda
  • Positive Physical Approach® (PPA™)
  • Positive Personal Connectors (PPC)
  • Positive Action Starters (PAS)
  • Hand-under-Hand® (HuH®)
  • Assisting with rather than doing to
  • GEMS® states identification
  • Adapting approach for situation or GEM
  • Becoming a Sapphire, flexible and fluid

PAC Skills Champions
stand alongside those living with dementia to offer relationships that are authentic, empowering, compassionate, and curious.

 PAC Champion skills begin with the initial approach and  connection to build a relationship for care. You must know your agenda, but not show your agenda. Positive Physical Approach (PPA) is a dynamic assessment of the other person’s willingness, comfort, and ability to engage and interact. PPA uses as many retained skills as possible in order to do with, not to when caring for someone living with dementia.

Why a hand-shake? At the edge of personal space, PPA begins by showing an open right hand near the face, and once observed, offering it outward in a traditional western-American culture hand-shake is our way of announcing our heritage and background. Acceptance of the hand-shake allows touch with permission using the right hand only. A PAC approach gives respect to the person and allows for him or her to be in charge of the interaction, no matter the skills or abilities of language that remain, as this type of dynamic assessment allows for all five of the senses to be alert and aware.

What if they don't offer their hand back? It is then our responsibility to notice the other person’s reaction or response to that offer. It turns out there are a multitude of physical greeting behaviors that vary by cultural heritage. If we have had the luxury of having prior knowledge or information about the person and their cultural background, we might prepare ourselves to pause, if the American handshake is not being accepted, enjoyed, or noticed. We might then offer something that attempts to approximate that person’s cultural greeting pattern or remain out of personal space to interact and see if their response or reaction changes. It is our responsibility to be flexible and adapt the steps for each person and each interaction.

We might also take a minute to observe the person prior to an interaction. If the person is an elder of a culture that shows respect and honor by using an alternate greeting, such as bowing, dropping one’s eyes, or offering a verbal honorific, then perhaps we might use that opening to our approach. If someone has experienced trauma or abuse at the hands of someone else, offering more space and time before touch is offered may help to build a stronger connection. Given that dementia is constantly progressing and changing, every new moment brings a possibility of surprise and a need for flexibility.

The ultimate goal of any approach is to move from a public space, to a personal connection, into a relationship that has value and purpose. Our willingness and ability to be flexible and responsive is the key to optimizing the possibilities. PAC Champions begin and end every interaction with a relationship focus.

Where to next?

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